Pregnancy Pitfalls After 40: What Are the Facts?

Many of today's women are delaying childbearing until later in life for a variety of reasons, including career choices, financial status, late marriage and remarriage. In addition, successful treatment of previously infertile women over 40 is occurring. In fact, news reports indicate successful pregnancies in women over age 60.

While such extreme cases raise complex social, ethical and medical issues, the fact of the matter is that more women over age 40 are choosing to start a new family or add to their present one. But what risks do these women incur? Let's examine the facts regarding pregnancy in this age group and strategies to reduce the risks.

The facts

Although women often have healthy pregnancies later in life, there is a higher risk for pregnancy complications. These complications include:

Medical illnesses affecting the mother and fetus

Genetic abnormalities and birth defects

Pregnancy loss

Labor and delivery complications

A higher risk of pregnancy complications can start as early as age 35. Nevertheless, proper preparation before pregnancy and early prenatal care can help assure the best chances of healthy outcomes.

Maternal illnesses: Certain medical conditions occur more frequently in pregnant women over 40, including diabetes, high blood pressure and thyroid disorders. Some of these conditions may not appear until pregnancy. The good news is that these conditions can be managed and, in many cases, will go away after the baby's birth.

Medical illnesses not related to pregnancy may be screened for, diagnosed and treated in advance. In cases like these, treatment course can improve the chances of a healthy pregnancy and baby. If not properly treated, maternal illnesses can adversely affect the fetus. Early prenatal care and judicious use of medication can lower these risks significantly.

Genetic defects: Unfortunately, as a woman ages, a higher proportion of her aging eggs contain chromosomal abnormalities. Therefore, women who become pregnant after the age of 35 are at risk of having a child with a genetic defect. This risk increases with age.

For instance, the likelihood of having a baby with Down syndrome increases from nearly 1 in 700 in the general population to 1 in 353 at the age of 35. This number increases to 1 in 85 by the age of 40 and up to 1 in 35 at the age of 45. If you are concerned about the risk of genetic defects, especially if you have a family history, ask your healthcare provider about tests that can help identify these types of problems.

Pregnancy loss: Pregnancy loss is often seen in the first trimester and in many cases is due to genetic abnormalities of the fetus. Pregnancy loss also increases with advancing age. For example, the risk of miscarriage for a 35-year-old woman is 20 percent, compared to an 80 percent chance of miscarriage when a woman reaches 45 years of age. Note: Risk of miscarriage increases with previous miscarriage(s).

Labor and delivery complications: Complications of labor and delivery that are seen more frequently in women over age 40 include:

Premature labor with or without premature birth

Abnormal placement of the placenta over the opening of the cervix

Increase in blood pressure during pregnancy

Fetal distress

Lowering the risks

Although the risks associated with pregnancy after 40 are sometimes unavoidable, there are several strategies that reduce these risks.

First and foremost, make an appointment to see your healthcare provider before you get pregnant. This preconception visit will give your provider an opportunity to diagnose and treat any disorders that might otherwise go undetected. Some other tips include:

If you are concerned about the risk of genetic defects, especially if you have a family history, ask your healthcare provider about tests that can help identify these types of problems before getting pregnant.